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Issue: October 2018
ByPeter G. Blake, MD
October 01, 2018
3 min read
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Supply of nephrolgists in Canada remains steady

Issue: October 2018
ByPeter G. Blake, MD

Canada has approximately 600 nephrologists for a population of about 34 million people, equal to about 17.6 nephrologists per million population or about one for every 40 patients on dialysis. More than 90% work in nephrology group practices and deliver care to chronic patients on dialysis.1 There are about 50 such groups nationwide and more than half are in academic centers.

Although more than half of Canadian nephrologists work in academic centers, a large proportion of their time is spent doing clinical work. Recent data show about two thirds of nephrologists are younger than 50 years old and almost one third are women, a notable increase from 20 years ago.1 Most are paid on a fee-for-service basis, although this income is significantly tithed in academic centers. Some academic nephrologists are mainly salaried through alternative funding plans.

Peter G. Blake

Supply of nephrologists

Nationwide, there is no sense of any present or imminent shortage of nephrologists as has been predicted in the United States. Permanent clinical positions are not difficult to fill except in some more remote locations. Recruitment to clinician scientist positions in academic centers may be a challenge and there is a perception of relatively less interest by nephrology trainees in predominantly research-based careers.

There is, however, a sense among internal medicine trainees that full-time nephrologist positions are difficult to secure, and this has led to between 10% and 30% of potential nephrology trainee positions being unfilled in recent years.2 For example, in the Canada-wide 2018 subspecialty resident match, 35 nephrology training positions were available but only 28 were filled.2

Surveys suggest this discrepancy is not due to a lack of popularity for nephrology or a concern that nephrologists’ incomes are inadequate. Rather, it is a feeling that permanent jobs are somewhat scarce, especially in large cities such as Toronto and Vancouver, where many want to live.1 Other concerns are thought to be high and complex clinical workload and consequent threat to work-life balance.

New positions

A recent survey of nephrology division chiefs, both academic and community, suggested 40 to 50 new nephrologist positions will be required annually in the years ahead but there is skepticism as to whether this is true, supported by the fact that only 33 to 36 training positions are advertised each year.1,2 Underlying this apparent mismatch is a sense that many senior nephrologists continue to work well after the age of 65 years and that many of the potential positions are specifically for academic researchers. In addition, there has been an impression that some community nephrology groups are reluctant for financial reasons to hire additional nephrologists, even when patient numbers expand.3

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A small number of qualified trainees have difficulty getting any permanent nephrologist position and some practice predominantly internal medicine or non-dialysis nephrology.1 It also should be noted that many nephrology trainees do at least one and often as many as 3 extra years of training after their 2-year residency is complete.1 This is the case even for many who are looking to be hired into community nephrology positions.

An additional factor is that, with a significant number of unfilled training positions each year and with a large volume of clinical work, many nephrology programs in academic centers have training positions for international medical graduates. For example, 10 to 20 nephrology residents from Middle Eastern countries, most notably Saudi Arabia, are taken on by academic centers each year, though this is now threatened by recent political developments.4 These trainees are typically funded by their own governments and most return to their own countries once training is complete.

In summary, Canada does not have a significant nephrologist workforce problem at this time. In contrast to the situation in the United States, nephrology remains relatively popular among Canadian internal medicine trainees and only about 10% to 15% of staff nephrologists are international medical graduates.5

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  • Peter G. Blake, MD, is with the division of nephrology at Western University, London in Ontario, Canada, and is a member of NN&I’s Editorial Advisory Board.